During the period 1996 to 2003 the number of GP services per capita in Australia fell by 14 percent and the proportion of services bulk billed (ie provided at no cost to the patient) fell by 12 percentage points. The Government responded to these trends by outlaying hundreds of millions of dollars to increase Government medical insurance rebates, to increase the number of GPs in Australia, and to provide incentives for GPs to bulk bill. ¶ There has been no comprehensive modelling of the GP market to assist in understanding the reasons for either the declining trends or whether the Government responses were successful. This thesis aims to fill that gap. ¶ Previous Australian modelling of the GP market has been cross sectional and mostly demand focused. This thesis uses panel data to minimise the biases caused by unobserved heterogeneity and border crossing, and to estimate explicit supply and demand equations to enable the relationship between supply and demand to be explored. ¶ This approach estimates the impact on GP market outcomes of both policy decisions regarding rebates and GP numbers, and of external changes such as the trends in social attitudes and age. The likely future paths of the market without further policy change can be considered, and the measures needed to meet given policy targets determined. ¶ In addressing these questions it is also shown that supplier induced demand does apply in Australian general practice but is not material, that previous cross sectional analysis was biased due to border crossing by patients, that GPs who charge patients with concession cards less than other patients are behaving economically rationally, and that when the Government increases the Medicare rebate payment, 85% of the increase goes to the GP and 15% to the patient. The analysis also shows that GP density has no significant effect on mortality in Australia, and was unable to detect any effect of the business cycle on mortality. ¶ The demand curve for Australian general practice services is shown to be fundamentally determined by the real value of the MBS rebate in the short term, where the real value adjusted for growth in average weekly earnings. ¶ The supply curve is determined by aggregate numbers of GPs and by the number of services they each provide. The average number of services provided per GP is determined by GP age and gender, but more importantly by a trend effect thought to be due to attitudinal changes which must be explored further, and must be incorporated into any prediction of GP market outcomes. ¶ The thesis provides the first empirically based overview of the behaviour of the GP market at end of the twentieth century, and shows how Government policy levers and other trends interact to generate the market outcomes. If the Government has targets for service levels or charging patterns in general practice, these models can facilitate determination of the policy options appropriate to achieve those targets.

Dans l’ensemble de la thèse, nous avons appliqué des techniques de ‘mesure des variations spatiales’ pour l'étude des variations géographiques de taux d'hospitalisation en France. La thèse est composée de 4 études :Étude 1 : « Variation géographique des recours aux procédures chirurgicales en France en 2008-2010 et comparaison avec les États-Unis et la Grande-Bretagne ».Étude 2 : « Variation géographique des admissions pour les prothèses du genou, de la hanche et la fracture de la hanche en France : existence d’une demande induite dans le secteur des hôpitaux à but lucratif et dans les hôpitaux public et privés à but non-lucratif »Étude 3 : « Caractéristiques et tendances des admissions non urgentes à but lucratif et sans but lucratif hôpitaux en France en 2009 et 2010 ». Étude 4 : « Taux d'admission pour des ’hospitalisations évitables par le système ambulatoire’ (ACSC) en France en 2009-2010 : tendances, variation géographique, coûts et comparaison internationale ». / For all of this work, we applied ‘small-area variation’ techniques to the study of geographic variations in hospitalization rates in France. We conducted four studies:Study 1: Geographic variation in rates of common surgical procedures in France in 2008-2010 and comparison to the US and BritainStudy 2: Geographic variation in admissions for knee replacement, hip replacement, and hip fracture in France: evidence of supplier-induced demand in for-profit and not-for profit hospitalsStudy 3: Characteristics and patterns of elective admissions to for-profit and not-for-profit hospitals in France in 2009 and 2010Study 4: Rates of admission for ambulatory care sensitive conditions in France in 2009-2010: trends, geographic variation, costs, and an international comparison

Freeways have had a strong influence not only on the urban transportation but also on downtown areas both physically and socially. Certainly, they have extended the commuting limits of the city and made lower land costs more accessible. However, many of the mid-century freeways, once championed by planners as tools for urban renewal, have created swaths of blight through city neighborhoods. Their negative impacts on the larger urban framework requires new ideas for healthier alternatives to aid in preserving and building sustainable cities. Removal of any downtown highway requires careful thought— even more consideration than when it was built. Quick solutions are what resulted in the problems that downtown highways of the Interstate-Era have today. If it is the simple interactions between people and place are that make up the positive aspects an urban environment, then what are the possibilities and strategies for removing urban highway, which are one of the primary impediments separating people in place in contemporary cities? This question is the focus of this thesis. At its core, the removal of freeways represents a trade-off between mobility objectives and economic development objectives. Evidence from other cities’ decisions to redesign or remove their downtown highways suggests multiple benefits. Making design changes, such as to replace a downtown highway with a well-designed surface boulevard, can stimulate economic activities without necessarily causing traffic chaos. Solutions come in different shapes and sizes. The selected case studies in this thesis reflect a diversity of approaches – suggesting no single strategy exists for addressing downtown highway issues. This reflects the fact that multiple alternatives must be considered in every situation because each approach varies in costs and opportunities. A typology of highway alternations derived from the case studies includes seven different techniques: burying, demolishing, taming, capping or bridging, elevating, retaining, and relocating. The final chapter applies the conclusions from the case studies to the Downtown Connector– Interstate 75/85– in Downtown Atlanta, Georgia. Urban design and transportation planning has an emerging new set of values. Transportation planning is seeking to promote alternate modes of transportation to the private vehicle, like transit, by foot, or by bicycle. We now understand that connectivity is not served only by highways but also by urban street networks that invite modes other than just automobiles. An important role for urban design will be to shape the way these interactions are made to benefit the citizens, its urban spaces, and the economy.

Cette thèse a pour objectif de mettre en évidence les déterminants de l'innovation médicale et ses effets sur la croissance économique. Elle repose sur la construction d'une base de données répertoriant les dépenses et les consommations de biens et services de santé entre 1980 et 2010, ainsi que sur trois modèles théoriques. Les résultats établis, pour les cohortes nées entre 1923 et 2010, mettent en évidence que les innovations médicales sont essentiellement déterminées par les variations démographiques. Par ailleurs, même si ces innovations médicales ont historiquement permis l'apparition d'importantes économies d'échelles, elles ne jouent pas actuellement un rôle moteur dans la croissance macro-économique. En effet, dans les conditions actuelles de stabilité des courbes de survie, cette mécanique de l'innovation médicale n'apparaît pas comme une force motrice de la croissance macro-économique de court terme. Les effets multiplicateurs de l'innovation médicale sur la croissance économique seraient donc, à court terme, négatifs ou nuls. / This thesis aims to highlight the determinants of medical innovation and its impact on economic growth. It is based on building a database of spending and consumption of health goods and services between 1980 and 2010, and also on three theoretical models. Established results for cohorts born between 1923 and 2010 show that medical innovations are mainly determined by demographic changes. Moreover, even if these medical innovations have historically allowed the emergence of significant economies of scale, they do not currently play a leading role in macro-economic growth. Indeed, in the current conditions of stability of the survival curves, the mechanics of medical innovation does not appear as a driving force for macroeconomic growth short term. The multiplier effects of medical innovation on economic growth would be, on the short-term, negative or zero.